Joint Status Research Articles

Assessment of haemophilic joints in a low‐resourced area using clinical tools: The effect of different types of prophylaxis

AbstractIntroductionHaemophilic arthropathy (HA) is the most frequent complication in people with haemophilia (PWH). MRI is the gold standard to assess HA, however, there are limitations to its use in low‐resourced areas.AimPrimary; to compare clinical‐functional, laboratory, and ultrasonographic joint scores with MRI scores to determine a reasonable alternative to MRI. Secondary; to identify the effect of various replacement therapies on the degree of joint involvement.Material and methodFifty PWH with at least one affected joint, with or without inhibitors, and receiving either on‐demand treatment or secondary prophylaxis, were included. All participants had a joint assessment by clinical HJHS 2.1, functional FISH, HEAD‐US, and MRI DENVER scores. Also, serum COMP level was assessed by ELISA for the PWH and 50 healthy subjects as control.ResultsThe HJHS 2.1 scores had a significant positive correlation with HEAD‐US and the MRI DENVER scores. The FISH score had a significant negative correlation with HJHS 2.1, HEAD‐US, and MRI DENVER Scores. The serum COMP level was comparable between the PWH and the controls. The HEAD‐US score had a significant positive correlation with the MRI score. All of the joints’ scores for the PWH on Emicizumab prophylaxis showed significantly lower HJHS 2.1 and MRI DENVER scores but higher FISH score than the joint scores of the patients receiving other types of prophylaxis.ConclusionThe clinical‐functional joints assessment scores (HJHS 2.1, FISH) were objective tools that correlated significantly with the HEAD‐US and the Denver MRI scores. Emicizumab prophylaxis led to better joint status.

Amyloid-β positivity is less prevalent in cognitively unimpaired KLOTHO KL-VS heterozygotes.

Klotho, encoded by the KLOTHO gene, is an anti-aging and neuroprotective protein. KLOTHO KL-VS heterozygosity (KL-VSHET) is hypothesized to be protective against the accumulation of Alzheimer's disease (AD) neuropathological hallmarks (amyloid-β (Aβ) and tau). We examine whether being positive for Aβ (A+) or tau (T+), or A/T joint status [positive for Aβ (A + T-), tau (A-T+), both (A + T+) or neither (A-T-)] vary by KL-VS and whether serum klotho protein levels vary based on A+, T+, or A/T status in a cohort enriched for AD risk. The sample consisted of 704 cognitively unimpaired, late middle-aged, and older adults; MeanAge(SD) = 64.9(8.3). Serum klotho was available for a sub-sample of 396 participants; MeanAge(SD) = 66.8(7.4). Covariate-adjusted logistic regression examined whether A + or T+, and multinomial regression examined whether A/T status, vary by KL-VS genotype. Covariate-adjusted linear regression examined whether serum klotho levels differ based on A+, T+, or A/T status. A+ prevalence was lower in KL-VSHET (p = 0.05), with no differences in T + prevalence (p = 0.52). KL-VSHET also had marginally lower odds of being A + T- (p = 0.07). Serum klotho levels did not differ based on A+, T+, or A/T status (all ps ≥ 0.40). KL-VSHET is associated with lower odds of being positive for Aβ, regardless of whether one is also positive for tau. Conversely, the likelihood of being tau positive did not differ based on KL-VS genotype. Our findings add to the growing KLOTHO literature and suggests the need for further research focused on understanding the mechanisms underlying KL-VS-related putative resilience to AD.

Predictive analysis of osteoarthritis and chronic pancreatitis comorbidity: complications and risk factors.

The comorbidity of chronic pancreatitis (CP) in patients with osteoarthritis (OA) is insufficiently studied, and the reciprocal impact of these conditions remains poorly understood. This study aimed to investigate potential predictors for the development of CP in OA patients, as well as associated complications. A cohort of 181 patients was categorized into four groups: a control group (n=30), patients with OA (n=68), patients with CP (n=31), and patients with OA and comorbid CP (n=52). All four groups had no statistical differences in age and gender. The study utilized the WOMAC index, Visual Analog Scale (VAS), Lequesne index, biochemical assays, and advanced statistical methods to assess joint status in OA patients with comorbid CP. It explored potential predictors of comorbidity development and associated complications. The study revealed that concurrent CP in OA exacerbates progression and contributes to malnutrition. Body Mass Index (BMI) emerged as a potential predictor for CP comorbidity development in OA patients. Factors such as the WOMAC total score, fecal elastase-1, C-reactive protein (CRP), ferritin, retinol, tocopherol, 25-hydroxyvitamin D3, and BMI were found to influence the development of comorbidity of CP in OA. Additionally, Gastrointestinal Symptom Rating Scale-Diarrhea Syndrome (GSRS-DS), Gastrointestinal Symptom Rating Scale-Constipation Syndrome (GSRS-CS), Qualitative Assessment of the Symptoms and Impact of Pancreatic Exocrine Insufficiency Domain A (PEI-Q-A), retinol, tocopherol, and iron were identified as potential predictors comorbidity CP with exocrine pancreatic insufficiency in OA patients. The presence of CP in OA patients exacerbates disease progression and complications, necessitating further investigation.

Correlation between proprioception, functionality, patient-reported knee condition and joint acoustic emissions.

Non-invasive assessment of joint status using acoustic emissions (AE) is a growing research area that has the potential to translate into clinical practice. The purpose of this study is to investigate the correlation of the knee's AE with measures of proprioception, self-assessment, and performance, as it can be hypothesised that, AE parameters will correlate with joint function metrics due to AE being recorded during interaction of the articular surfaces. Threshold to detect passive motion (TTDPM), Knee Osteoarthritis Outcome Scores (KOOS) and 5 times sit-to-stand test (5STS) were collected from 51 participant. Knee AE were recorded during cycling with 30 and 60 rpm cadences using two sensors in different frequency ranges and three modes of AE event detection. Weak (0.297, p = 0.048) to moderate (0.475, p = 0.001) Spearman's correlations were observed between longer 5STS time and AE parameters (i.e. higher median absolute energy, signal strength, longer AE event rise time and duration). Similarly, AE parameters shown correlation with lower KOOS, especially in the "Function in Sports and Recreation" and "Activities of Daily Living" subscales with correlation coefficients for higher median amplitude up to 0.441, p = 0.001 and 0.403, p = 0.004, respectively. The correlation with the TTDPM was not detected for most of the AE parameters. Additionally, a lower frequency sensor and 60 rpm cadence AE recordings showed higher correlations. Considering that this study included subjects from the general population and the number of participants with KOOS <70 was relatively small, higher correlations might be expected for clinically confirmed OA cases. Additionally, different ICCs might be expected for alternative signal parameters and proprioception assessment methods. Overall, the study confirms that AE monitoring offers an additional modality of joint assessment that reflects interaction between cartilage surfaces and can complement orthopaedic diagnostics, especially in the context of remote monitoring, drug testing, and rehabilitation.

An adaptive bionic sensor: enhancing ankle joint tracking with high sensitivity and superior cushioning performance

Flexible sensors are renowned for their rapid responsiveness, high flexibility, and outstanding mechanical properties, making them ideal for applications in wearable devices, sports and health monitoring, and human-machine interfaces. To enhance the sensing performance of these flexible sensors, researchers have drawn inspiration from nature, creating various bionic microstructures. However, these structures often manifest in the macroscopic form of thin films, which do little to improve impact resistance and joint protection. In response, this work achieves a highly sensitive and impact-resistant pressure sensor by integrating bionic principles at both micro and macro levels. Specifically, at the micro level, a muscle-like hydrogel system consisting of MXene nanosheets incorporated into the double network of polyvinyl alcohol and sodium alginate matrix is selected. At the macro level, the bionic prototypes of mimosa leaves and durian spikes with good energy absorption structure, together with octopus’ sucker with good adsorption capacity are selected, and the synergistic construction of the three structures is realized through 3D printing methods. The obtained sensor has an appropriate response range, sensitivity and stability. More importantly, the displacement deformation of the hydrogel can be reduced by 91.22%, while its adhesion strength can be increased by 57.5% compared to the unstructured hydrogel. As a proof-of-concept, the proposed bionic flexible sensor can be used to monitor the motion status of the human ankle joint in real-time, thereby assisting users in making real-time judgments on gait health.

Inflammatory back pain as an unusual manifestation of Takayasu arteritis: a case report.

Takayasu arteritis and spondyloarthritis are two rheumatological diseases whose co-existence is well-documented in the literature. Data on the presence of inflammatory back pain in Takayasu arteritis without a diagnosis of spondyloarthritis, however, is scarce. Here, we present a 33-year-old man who was admitted to the emergency department with acute-onset chest pain associated with left carotidynia, carotid bruit, and left arm claudication, normal electrocardiogram and computed tomography angiographic features suggesting Takayasu arteritis, including stenosis and occlusion of the aorta and its branches. Two years prior, he had undergone a clinical work-up for an inflammatory back pain accompanied by alternating buttocks pain, morning stiffness lasting more than half an hour, and heel pain. HLA-B27 status and magnetic resonance imaging of the sacroiliac joints were both negative. He was prescribed non-steroidal anti-inflammatory drugs and was placed on adalimumab 40 mg SC every two weeks but had to switch to etanercept two months before his emergency admission due to supply issues. Oral prednisolone was initiated at a dose of 60 mg/day with symptomatic improvement in both his inflammatory back pain and his chest pain, but he had to be switched to methotrexate and infliximab due to steroid side effects. Inflammatory aortitis should be considered as a possibility during the assessment of inflammatory back pain to mitigate the risks of delayed diagnosis.

Moderate haemophilia A: Recommendations from a Spanish panel of experts.

Diagnosing moderate haemophilia A (MHA) solely based on deficient FVIII protein levels limits its optimal management and delays the initiation of prophylaxis. Updating protocols and incorporating new variables into its diagnosis could prevent underestimating disease severity, avoiding early arthropathies and impairing patients' quality of life. To propose recommendations to improve the comprehensive management of people with MHA. Recommendations from a Spanish panel of eight experts from public comprehensive care centres (CCCs) for people with haemophilia and over 140 people with MHA in follow-up. In a previous analysis, the panel identified the unmet needs of people with MHA and the necessity to develop new specific recommendations for their management. The panel proposed recommendations in four areas: diagnosis, treatment, follow-up and referrals. They detailed the necessary steps and procedures for the diagnosis, adding other variables to the FVIII levels like bleeding phenotype, genetic profile and joint status to specify the severity and risk classification of people with MHA. Experts proposed an algorithm with unique independent criteria to facilitate the decision to initiate prophylaxis, where the recommended FVIII levels and variables coexist for treatment decision-making. Follow-up proposals addressed periodicity, recommended tests and required visits to CCCs. For referrals, experts proposed criteria and situations considered urgent for a transfer to a CCC for haemophilia patients. The proposals agreed upon by this expert panel can contribute to update and optimize the management of people with MHA, delaying joint deterioration, pain and disabilities, and improving their quality of life.

Is patella facet arthritis a contraindication to unicompartmental knee arthroplasty: Current concepts

Medial unicompartmental knee arthroplasty (UKA) has increased in popularity for the ​treatment of end-stage anteromedial osteoarthritis in part secondary to its quicker recovery, improved function, and decreased risk of medical complications over total knee arthroplasty (TKA). However, despite the success of medial UKA, dilemma still exists over certain patient characteristics as to suitability for undergoing the procedure. In addition to patient age, body mass index (BMI), and the presence, or lack thereof, of an anterior cruciate ligament (ACL), one of the most contentious issues surrounding suitability for medial UKA is the preoperative status of the patellofemoral joint (PFJ). This review aims to look at the historical factors leading to the current dilemma as well as recent evidence surrounding anterior knee pain and preoperative PFJ arthritis on the survivability and outcomes of medial UKA. This article will also evaluate other PFJ factors possibly affecting the outcome of medial UKA such as lateral patellar subluxation and lateral facet grooving, future perspectives that may influence the utilization of medial UKA such as cementless implants, and the choice of mobile versus fixed bearing articulations.

Radiological evaluation of fusion patterns after Lateral Lumbar Interbody fusion with 3D-printed porous titanium cages vs. conventional titanium cages.

The assessment of segmental fusion after Lateral Lumbar Interbody fusion (LLIF) using 3D-printed porous titanium cage is still not well studied. Various criteria, such as the presence of bone bridges (BB) between adjacent vertebrae, serve as indicators for anterior fusion. However, limited radiological studies have investigated zygapophyseal joints (ZJ) status following LLIF with porous titanium cages vs. conventional titanium threaded cages. The porous design of the latest titanium intervertebral cages is thought to enhance the bone-to-implant fusion rate. This radiological study aimed to compare the fusion patterns post-LLIF using 3D-printed porous titanium cages against those using threaded titanium cages. This radiological study aimed to compare the fusion patterns after LLIF using 3D-printed porous titanium cages against those using threaded titanium cages. This retrospective, single-center radiological study involved 135 patients who underwent LLIF and posterior percutaneous screw fixation for degenerative spondylolisthesis. The study included 51 patients (Group A) with the novel porous titanium cages and 84 patients (Group B) with conventional threaded titanium cages. Inclusion criteria mandated complete radiological data and a minimum follow-up period of 24 months. The study evaluated intervertebral bone bridges (BB) for anterior fusion and zygapophyseal joints (ZJ) ankylotic degeneration, based on Pathria et al., as evidence of posterior fusion and segmental immobilization. Two years after surgery, intervertebral BB were identified in 83 segments (94.31%) in Group A and in 87 segments (88.77%) in Group B. ZJ Pathria grade I was observed in 2 segments (2.27%) of Group A and in 4 segments (4.08%) of Group B. Grade II was seen in 5 segments (5.68%) of Group A and in 6 segments (6.12%) of Group B. Posterior fusion, classified as grade III, was found in 81 segments (92.04%) of Group A and 88 segments (89.79%) of Group B. Subsidence incidence was 5.88% (3 segments) for the novel cage and 9.88% (8 segments) for the conventional cage. The architecture of porous titanium cages offers a promising solution for increasing bone ingrowth and bridging space, supporting successful spinal fusion while minimizing the risk of subsidence.

The Treatment Algorithm for Chronic Multiple Ligament Knee Injury.

Multiple ligament knee injuries (MLKI) are a complex group of injuries ideally treated in the acute phase, though delayed presentation is common. Chronic MLKI varies in presentation, requiring individualized management strategies. This review aims to differentiate chronic MLKI types and propose an algorithm that facilitates a tailored treatment plan. Chronic MLKI is classified into three types based on knee joint status and limb alignment. Type 1 involves ligament deficiency in a reduced knee with normal alignment, treated with soft-tissue ligament reconstruction. Type 2 includes ligament deficiency with malalignment, where deformity correction precedes ligament surgery. Type 3 entails chronic unreduced knee dislocations, necessitating open reduction and extensive release prior to reconstruction. Treatment depends on classification, emphasizing realignment for Type 2 and reduction for Type 3 before soft-tissue procedures. Individualized approaches are critical due to the complexity and variability of chronic MLKI. A treatment algorithm is essential to manage chronic MLKI. Joint reduction, limb realignment, and ligament reconstruction are important to ensure optimal functional outcomes.

Levels of Tumor Necrosis Factor Alpha and Serum Ferritin in Patients with Hemophilia and Correlation with Clinical Data and Joint Arthropathy

Abstract Background Hemophilic arthropathy still represents a major concern especially in resource- limited settings, despite major advances in the management of patients with hemophilia worldwide. TNF-α has been enrolled in the pathophysiology of chronic hemophilic arthropathy. Aim: To evaluate levels of TNF-α and ferritin in patients with hemophilia in relation to hemophilic arthropathy. Methodology We conducted a 6-months comparative cross-sectional study including 38 hemophiliacs with arthropathy (HA+) and without arthropathy (HA−), who are mild, moderate and sever hemophilia; as well as 53 age- and sex-matched healthy control. Patients with a history of acute bleeding or inflammatory conditions in the previous four weeks were excluded from the study. We assessed every patient annual bleeding rate(ABR) measured serum levels of ferritin and TNF-α by using enzyme linked immune-sorbent assay (ELISA). joint status was assessed clinically by the Hemophilia joint health score (HJHS), and radiologically by the six major joints ultrasound (US) Results The median (IQR) age of hemophiliacs was 11.8 (9-16.1) years opposed to 11 (8-13) years in the control group (p = 0.435). Most patients (97.3%) received regular low dose prophylaxis. The median (IQR) HJHS among (HA−) was 0 (0 - 1) versus 18 (9 - 22) in (HA+) group (p &amp;lt; 0.001), and HJHS correlated well with the US score (p &amp;lt; 0.001, p &amp;lt; 0.001 and p = 0.005 for knee, ankle and elbow joints respectively). The annual bleeding rate (ABR) was comparable between both hemophilia groups with median (IQR) 0.88 (0- 2.25) in HA− group versus 1.25 (0.5- 1.75) in HA+ patients (p = 0.571). There was no significant difference in ferritin levels among hemophiliacs with median (IQR) in (HA+) and (HA-) of 40 (35-70) ng/ml and 30 (30-50) ng/ml respectively. On the other hand, TNF-α levels was significantly higher in hemophiliacs compared to control (p &amp;lt; 0.001); with median (IQR) 500 (390 -780) in HA− patients, 485 (385 -580) in HA+ group and 65 (50 - 95) for healthy controls. In a post-hoc analysis TNF-α levels were comparable among patients with and without arthropathy (p = 0.56). Conclusion Hemophiliacs display higher TNF-α levels when compared to healthy controls, which may be a useful surrogate biomarker for bleeding episodes.

Effectiveness of hydrotherapy on pain and functional status of shoulder joint among individuals undergone intra-articular injections

BackgroundThe shoulder complex with its varied pathology responds differently from patient to patient and so, the best option for progression is a choice of rehabilitation. In the present post-COVID scenario, many patients are referred to acute and sub-acute shoulder pain and dysfunction. It is very difficult to predict the outcome of therapy. Some patients recover even without any modalities. Recurrent or adverse symptoms are also possible. Gender, other demographic features, physiological response, and progressive outcome need to be considered in rehabilitation. This study is intended to evaluate the short-term effects of hydrotherapy post-intra-articular injections of shoulder dysfunctions.Aims and objectivesTo evaluate the effectiveness of hydrotherapy during early rehabilitation of individuals who have undergone intra-articular injections of shoulder joint on pain and function.Materials and methodsIn this prospective study, we have studied a total of 59 cases within the age group of 40–70 years with idiopathic frozen shoulder, acromio-clavicular joint dysfunction, and grade-1 untreated rotator cuff injuries. Group A patients were treated with conventional shoulder exercises and group B patients were treated in a hydrotherapy pool. The chief aim was to obtain earlier pain relief with controlled movement patterns and earlier relief from functional disability. The Constant-Murley score (CMS–100 points scale) composing pain and functional parameters was the outcome measure.ResultsAfter confounding all the demographic factors, it was found that the experimental group B treated by hydrotherapy revealed a statistically extremely significant difference (p value < 0.0001) at the end of the first week as compared to the conventional group. The treatment protocol was continued for 5 weeks. More than 90% of patients in the hydrotherapy group felt it easier and exercise participation progression was best. Better progression and improvement of shoulder function were achieved in the hydrotherapy group compared to the conventional group.ConclusionFrom this study, we conclude that hydrotherapy during early management of shoulder dysfunctions post-intra-articular injections is safer and provides excellent relief from pain as early as the first week. Functional progression is better and avoids complications related to mobilization.

3D bone shape from CT-scans provides an objective measure of osteoarthritis severity: Data from the IMI-APPROACH study

Decisions regarding total knee arthroplasty are usually made using a patient's own assessment of pain and the structural disposition of the joint as seen on plain film radiographs. Pain severity can fluctuate, and radiographs can be misleading, with the apparent joint status affected by anatomical orientation. An important component of the surgical management of knee osteoarthritis (OA) is the timing of surgical intervention: knee arthroplasty performed too early in the course of the disease may increase the need for revision surgery.Femoral 3D bone shape (B-score) from MR images is an objective measure of OA severity and has been correlated with current and future risk of pain. We aimed to derive the B-score from CT images and compare it against the B-score derived from MR images.We used baseline and 24-month image data from the IMI-APPROACH 2-year prospective cohort study, comprising pairs of CT and MR images taken for each subject-timepoint. The femur was automatically segmented in both CT and MR modalities using an active appearance model, a machine-learning method, to measure the B-score. Linear regression was used to test for correlation between measures. Limits of agreement and bias were tested using Bland-Altman analysis.CT-MR pairs of the same knee were available from 424 participants (78 % women). B-scores from CT and MR were strongly correlated (CCC = 0.980) with negligible bias of 0.0106 (95 % CI: −0. 0281, +0.0493).The strong correlation and small B-score bias suggests that B-scores may be measured reliably using CT images. Since CT images are used in planning robot-assisted knee arthroplasty, with further study B-scores derived from CT surgical planning images could in principle provide a useful objective input to deciding the appropriateness, timing and type of knee arthroplasty.

Two-Year Outcomes are Equal in Kellgren-Lawrence Osteoarthritis Grades 1-4 after Total Knee Arthroplasty with Medial-Pivot Implants and Kinematic Alignment.

Introduction While risks exist with total knee arthroplasty (TKA) and survivorship is not indefinite, delaying surgery may lead to further deterioration of the knee joint, functional outcomes, and health status. Most studies report that patients with high-grade osteoarthritis (OA) scores have higher satisfaction and functional scores, cautioning against TKA in those with lower OA grades. This study correlates Kellgren-Lawrence (KL) OA scores with outcomes following kinematically-aligned TKA. Methods Preoperative anteroposterior weight-bearing radiographs of 168 patients enrolled in a prospective trial were scored for KL grade. Patients were segregated into two groups: the low-grade OA group had KL scores of 1 or 2, the high-grade OA group had a KL score of 3 or 4. Outcomes as measured with Forgotten Joint Score (FJS), Knee Society Score (KSS), and Range of motion were compared up to 2-years. Results There were 29 subjects with low-grade KL scores and 127 with high-grade KL scores. There were no differences in BMI, age, or gender distribution. The only statistically significant difference was in the preoperative KSS Pain/Motion score, 60.6 in the low-grade OA group vs. 46.4 in the high-grade group (P&lt;0.008). There were no significant differences between the groups in FJS at one or two-year follow-up. There were no differences in KSS Functional or Composite Scores, or in range of motion (ROM) at pre-op, 1-year or 2-years, and in KSS Pain/Motion at 1 or 2-years. Conclusion There were no significant differences in FJS, KSS, and ROM in patients with low- vs. high-grade OA up to 2-year follow-up. Patients with lower grade OA demonstrated substantial improvements in their FJS, KSS scores, and ROM indistinguishable from the higher-grade OA cohort up to 2-years, suggesting no shorter-term downside to earlier intervention with kinematically-aligned medial-pivot (MP) TKA.

Platelet rich plasma injection in knee osteoarthritis: results after four years.

Background Knee osteoarthritis (KOA) is a progressive degenerative disease and a leading cause of disability worldwide. Intra-articular injection of platelet-rich plasma (PRP) is still a debatable symptomatic treatment and has provided multiple publications in literature with mixed results. Aim of the work To evaluate the short and long term effects of intra-articular injection of PRP on pain and functional status of the knee joint as measured by the Lysholm questionnaire and visual analogic pain scale (VAS). Patients and methods Twenty-one patients with primary Kellgren-Lawrence grade 3 KOA were assessed using the Lysholm questionnaire and the visual analogue scale for pain (VAS). A single PRP injection was administered, followed by reassessment of VAS at the first, fourth and eighth weeks after the injection. After eight weeks, patients were assessed with VAS and Lysholm questionnaire. In order to evaluate the long term effect of this single injection, we reassessed the patients four years after the injection using the same method. Results Fifteen females (71%) and six males (29%) with mean age 60 years (ranging from 44 to 76 years) were enrolled. After a single PRP injection, there was significant improvement in Lysholm and VAS. Before the injection, VAS medium score was 7 (ranging from 5 to 9) and we observed improvements in all assessments at the first (medium VAS 2), fourth (medium VAS 2) and eighth week (medium VAS 2) post injection and was still better than the pre injection score after 4 years (medium VAS 4). This was also observed in Lysholm score. The pre injection score was 41; at 8 weeks, 84; at 4 years, 66. Conclusion PRP injection achieves good results in the symptomatic treatment of Kellgren-Lawrence grade 3 KOA. This study confirmed that a single PRP injection can provide a long-term effect in pain reduction and functional status improvement in KOA, despite the progression of the disease. Further studies with more patients and randomized double blinded controlled studies are recommended to confirm these results.

Factors influencing the survival status of the hip joint in post-collapse femoral head necrosis

BackgroundDespite hip function typically deteriorating in the post-collapse stage of osteonecrosis of the femoral head (ONFH), some patients can still demonstrate long-term favorable hip function, a state termed “survival with collapse”. This study aims to identify the characteristics of patients suitable for “survival with collapse” in cases of ONFH.MethodsThis cross-sectional study included 65 patients (87 hips) diagnosed with post-collapse ONFH for ≥ 3 years (average 9.1 years, range 3–23 years). Hip function was assessed using the Harris Hip Score (HHS). Demographic, clinical, and radiographic data were compared between the favorable group (HHS > 80) and the poor group (HHS ≤ 80). Independent protective factors for hip function were identified by multivariate analysis and receiver operating characteristic (ROC) curve analysis was further applied to evaluate these factors’ diagnostic efficacy.ResultsThe favorable and poor groups included 46 and 41 hips, respectively. Significant differences were found in body mass index (BMI), Association Research Circulation Osseous (ARCO) stage, collapse degree, Japanese Investigation Committee (JIC) classification, necrotic size, and hip subluxation between the two groups (p < 0.05). Multivariate logistic regression identified collapse < 3 mm(OR:14.49, 95%CI: 3.52–59.68, p < 0.001), JIC types B (OR: 11.08, 95% CI: 1.07-115.12, p < 0.05) and C1(OR: 5.18, 95% CI: 1.47–18.20, p < 0.05) as independent protective factors for hip function, while BMI (OR: 0.76, 95% CI: 0.59–0.97, p = 0.029) was an independent risk factor. ROC curve analysis demonstrated that both collapse degree (AUC = 0.798, sensitivity = 91.3%, specificity = 68.3%, p < 0.0001) and JIC classification (AUC = 0.787, sensitivity = 80.4%, specificity = 73.2%, p < 0.0001) had satisfactory diagnostic value for hip function. Combining JIC classification and collapse degree (AUC = 0.868, sensitivity = 76.1%, specificity = 85.4%, p < 0.0001) significantly enhanced diagnostic efficacy compared to using either alone (p < 0.05).ConclusionIn ONFH, femoral head collapse does not necessarily determine a poor prognosis. Patients with mild collapse (< 3 mm) and preserved anterolateral wall are more likely to retain satisfactory hip function, making them candidates for “survival with collapse.”

Analysis of the Effect of Exams on Perceived Stress and Temporomandibular Joint Status in Physiotherapy Students: A Pilot Study.

Background and Objectives: Temporomandibular disorders or dysfunction (TMDs) encompass a range of complex conditions that impact the temporomandibular joint (TMJ), chewing muscles, teeth, and/or their supporting tissues. Stress is one of the most associated factors studied as a TMD predictor. The aim is to figure out the influence of stress on TMJ status and salivary cortisol in university students during and before exams. Materials and Methods: The study was non-experimental, employing a longitudinal, analytical, observational cohort design. The study population consisted of students enrolled in the physiotherapy degree program at the Alfonso X El Sabio University (Madrid, Spain). Data were collected during two distinct academic periods: the first period was characterized by low academic stress and no exams, and the second period coincided with the high academic stress of final course exams. The collected results included sociodemographic data, assessment of TMJ status (Fonseca Index), evaluation of muscle evaluation (masseter, upper trapezius, and sternocleidomastoid) using a MOXY Monitor (muscle oxygenation) and Neurotrac® (surface EMG, sEMG), assessment of perceived stress (PSS-14), and measurement of salivary cortisol (enzyme immunoassay with Elisa). The statistical analysis was conducted with a confidence level of 95% (p ≤ 0.05) and asymptotic or bilateral significance. Results: 70 students were analyzed during two different measurement periods. According to the Fonseca Index, initially, 37.14% of the analyzed students showed mild TMDs, 17.14% moderate TMDs, and 45.72% showed no TMDs. In general terms, stress increased with age and is related to female sex, maximum mouth opening decreased with age, oxygen saturation decreased with age and academic stress, and myoglobin concentration was related to age. Furthermore, muscle contraction decreased during higher academic stress and increased with age. For women, age was a risk factor for suffering from TMDs, and stress worsened the transition from having TMDs to having no TMDs in both sexes. Conclusions: Academic stress influences TMJ status and muscle outcomes such as oxygen saturation, myoglobin concentration, and muscle contraction, although more research is needed.

Functional clinical motor performance tests to assess potential fall risks in patients with haemophilia: A case-control study.

Patients with haemophilia (PwH) are at increased risk of falls due to haemophilic arthropathy. Yet, studies on clinical tests associated with the risk of falling are scarce in PwH. (1) To evaluate the feasibility of different clinical motor performance tests associated with the risk of falling in PwH; (2) to evaluate PwH's performance of these tests compared to a control group; (3) to identify possible influencing factors that affect performance. Twenty-nine severe and moderate PwH (57.0 years, IQR: 48.0-61.5) and 29 healthy age- and BMI-matched control participants (CG) performed 13 different clinical tests (SPPB, timed up and go, push and release, functional reach, single-leg stance, knee and grip strength). Haemophilia joint health score (HJHS), kinesiophobia (TSK-11), subjective physical performance (HEP-Test-Q), falls efficiency (FES-I) and falls were assessed. No adverse events occurred. PwH showed impaired performance in all clinical tests, a lower falls efficiency and a higher HJHS than CG. PwH with higher HJHS, lower HEP-Test-Q and higher TSK-11 scores showed higher deficits. Largest discrepancies were observed in the single-leg stance with eyes open and knee extensor strength, where orthopaedically majorly affected PwH showed worse performance compared to minorly affected PwH and the CG, respectively. The prevalence of ≥1 fall in the last year was 27.6% (PwH) and 10.3% (CG). These clinical tests are feasible in PwH. Impaired joint status, a high kinesiophobia and low physical performance impair performance. These tests can be used by clinicians for gaining specific information on functional motor abilities of patients.

A Biomimetic Osteochondral Scaffold Augmented With Filtered Bone Marrow Aspirate for the Treatment of Joint Surface Lesions in the Knee

Background: Multilayered osteochondral scaffolds are becoming increasingly utilized for the repair of knee joint surface lesions (KJSLs). However, the literature on predictive factors is rather limited. Purpose: To (1) evaluate the clinical outcomes and safety of a combined single-step approach using a biomimetic collagen-hydroxyapatite scaffold (CHAS) and filtered bone marrow aspirate (fBMA) for the treatment of KJSLs and (2) identify significant predictors of the treatment outcomes. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent surgery because of a KJSL (size ≥1.5 cm2; International Cartilage Regeneration & Joint Preservation Society grades 3-4) using the combination above were selected from a hospital registry database (100 patients; minimum 2-year follow-up). Patient characteristics, medical history, knee joint and lesion status, intraoperative details, and cellular parameters of the injected fBMA were collected. The arthroscopic evaluation of chondral and meniscal tissue quality in all knee compartments was performed using the Chondropenia Severity Score. Treatment outcomes were determined clinically using patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, EuroQol–5 Dimensions–3 Levels, EuroQol–Visual Analog Scale, and Tegner Activity Scale) and by assessing the occurrence of serious adverse events and graft failure. Multivariable regression analysis was performed to identify significant predictors of the treatment outcomes. Results: At a mean follow-up of 54.2 ± 19.4 months, 78 (87%) patients completed the questionnaires with significant improvements toward the baseline (P < .00625): KOOS Pain subscale from 62 ± 17 to 79 ± 18, KOOS Total score from 57 ± 16 to 70 ± 20, EuroQol–Visual Analog Scale from 61 ± 21 to 76 ± 16, EuroQol–5 Dimensions–3 Levels from 0.57 ± 0.20 to 0.80 ± 0.21, and Tegner Activity Scale from 2.8 ± 1.5 to 3.9 ± 1.9. The graft failure rate was 4%. A longer duration of preoperative symptoms, previous surgery, larger lesions, older age, and female sex were the main negative predictors for the treatment outcomes. The Chondropenia Severity Score and the number of fibroblast colony-forming units in fBMA positively influenced some of the clinical results and safety. Conclusion: A CHAS augmented with fBMA proved to be an adequate and safe approach for the treatment of KJSLs up to midterm follow-up. Based on the subanalysis of predictive factors, the surgical intervention should be performed in a timely and precise manner to prevent lesion enlargement, deterioration of the general knee cartilage status, and recurrent surgical procedures, especially in older and female patients. When a CHAS is used, the quantity of MSCs seems to play a role in augmentation. Registration: NCT06078072 (ClinicalTrials.gov identifier).

Clinical analysis and quality of life survey of hemophilia B patients in the central and western regions of China.

To study the current status of hemophilia B (HB) patients in the central and western regions of China. This cross-sectional, multicenter study was conducted in seven provinces in the central and western regions of China from April 2019 to June 2023. Samples were collected for the factor IX activity, inhibitor screen, and gene mutation. Furthermore, the status of six index joints and quality of life (QoL) were assessed. A total of 185 HB patients (mild 15, moderate 75, and severe 95) with a median age of 12.17 years were enrolled. 30.3% (56/185) of patients had a family history of HB. 34.6% (64/185) of HB patients had diagnostic delay and 38.5% (69/179) experienced treatment delay. The incidence of inhibitors was 6.1% (11/179). We identified 123 genetic variants in this study, with missense mutations being the most common. 84.0% (89/106) of HB mothers were genetically identified as carriers, with 27.7% (13/47) of carriers having clotting factor levels less than 0.40 IU/ml. 71.4% (132/185) of HB patients had a history of joint hemorrhage, with a rate of target joint in these patients was 64.4% (85/132). Lower extremity joints were most often affected in patients. The Hemophilia Joint Health Score (HJHS) score was significantly positively correlated with the Hemophilia Early Arthropathy Detection with Ultrasound in China (HEAD-US-C) (r = 0.542, P < 0.001). Patients who received prevention treatment, inhibitor negative, without treatment delay, and without high-intensity replacement therapy showed a higher total score of the short form-36 health survey (SF-36). One-third of HB patients had delay in diagnosis and treatment, and the incidence of inhibitors was 6.1%. Target joints were present in nearly half of HB patients. Missense was the main mutation type. 84.0% of mothers of HB patients in this study were found to be carriers. HEAD-US-C and HJHS can complement each other in the evaluation of joint status and give a valid basis for early clinical management. Early detection and preventive treatment, as well as reducing high-intensity replacement therapy and inhibitor generation, can effectively improve the QoL of patients.